Predictors of improvement in diastolic function after transcatheter aortic valve implantation

被引：5
作者：
Maayan K. [1 ,2 ]
Simon B. [1 ,2 ]
Yan T. [1 ,2 ]
Yigal A. [1 ,2 ]
Ofer H. [1 ,2 ]
Eyal B.-A. [1 ,2 ]
Eran L.-R. [1 ,2 ]
Yaron A. [1 ,2 ]
Gad K. [1 ,2 ]
Shmuel B. [1 ,2 ]
Ariel F. [1 ,2 ]
机构：
[1] Department of Cardiology, The Tel Aviv Sourasky Medical Center, Tel Aviv
[2] Tel Aviv University, Tel Aviv
来源：
Journal of Echocardiography | 2014年 / 12卷 / 1期
关键词：
Concentric hypertrophy; Concentric remodeling; Diastolic function; Transcatheter aortic valve implantation;
D O I：
10.1007/s12574-013-0195-8
中图分类号：
学科分类号：
摘要：
Background: Aortic stenosis is associated with concentric left ventricle (LV) hypertrophy or remodeling resulting in impaired diastolic function and elevated left-sided filling pressure. We investigated the changes in LV geometry and LV filling hemodynamics, giving emphasis to parameters associated with changes in diastolic function after transcatheter aortic valve implantation (TAVI). Methods: Comprehensive diastolic assessment was performed before and six months after TAVI in 70 patients with severe aortic stenosis. Patients with any degree of mitral stenosis or >mild left-sided valvular regurgitation were excluded. Results: In the entire cohort six months after TAVI, LV end-diastolic diameter increased (44.1 ± 6 versus 45 ± 6 mm, P = 0.02), whereas LV mass and relative wall thickness (RWT) decreased (270.1 ± 76 versus 245.1 ± 75 g and 0.53 ± 0.15 versus 0.46 ± 0.1, respectively; P < 0.0001 for both). Lateral e′ increased (5.8 ± 2 versus 6.6 ± 3 cm/s, P = 0.03) and left atrium (LA) volume, E/e′ ratio, and systolic pulmonary pressure decreased (88.1 ± 30 versus 80 ± 28 cc, 18 ± 7.8 versus 16.3 ± 5.5, and 42.7 ± 14.9 versus 38.7 ± 12 mmHg, respectively; P < 0.05 for all), suggesting reduction in LA pressure. The improvement in LA volume and E/e′ was almost exclusively seen in patients with LV hypertrophy before TAVI (P < 0.05 both), as opposed to patients with concentric remodeling. Conclusions: In our preliminary study, TAVI resulted in LV and LA reverse remodeling, and improved LV relaxation and LA filling pressure in patients with severe aortic stenosis and concentric hypertrophy. Patients with concentric remodeling at baseline seem to have limited improvement in LV diastolic function and filling pressure following TAVI, but larger clinical trials would be required to conclude if they have no improvement at all. © 2013 Japanese Society of Echocardiography.
引用
收藏
页码：17 / 23
页数：6
相关论文
共 21 条
  • [1] Carabello B.A., Paulus W.J., Aortic stenosis, Lancet, 373, pp. 956-966, (2009)
  • [2] Holmes Jr. D.R., Mack M.J., Kaul S., Et al., ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement, J Am Coll Cardiol, 59, pp. 1200-1254, (2012)
  • [3] Yarbrough W.M., Mukherjee R., Ikonomidis J.S., Et al., Myocardial remodeling with aortic stenosis and after aortic valve replacement: mechanisms and future prognostic implications, J Thorac Cardiovasc Surg, 143, pp. 656-664, (2012)
  • [4] Devereux R.B., Wachtell K., Gerdts E., Et al., Prognostic significance of left ventricular mass change during treatment of hypertension, Jama, 292, pp. 2350-2356, (2004)
  • [5] Kupari M., Turto H., Lommi J., Left ventricular hypertrophy in aortic valve stenosis: preventive or promotive of systolic dysfunction and heart failure?, Eur Heart J, 26, pp. 1790-1796, (2005)
  • [6] Park S.J., Enriquez-Sarano M., Chang S.A., Et al., Hemodynamic patterns for symptomatic presentations of severe aortic stenosis, JACC Cardiovasc Imaging, 6, pp. 137-146, (2013)
  • [7] Vahanian A., Baumgartner H., Bax J., Et al., Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology, Eur Heart J, 28, pp. 230-268, (2007)
  • [8] Vizzardi E., D'Aloia A., Fiorina C., Et al., Early regression of left ventricular mass associated with diastolic improvement after transcatheter aortic valve implantation, J Am Soc Echocardiogr, 25, pp. 1091-1098, (2012)
  • [9] Lang R.M., Bierig M., Devereux R.B., Et al., Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology, J Am Soc Echocardiogr, 18, pp. 1440-1463, (2005)
  • [10] Nagueh S.F., Appleton C.P., Gillebert T.C., Et al., Recommendations for the evaluation of left ventricular diastolic function by echocardiography, Eur J Echocardiogr, 10, pp. 165-193, (2009)
123